"Not Enough Money" Is no Excuse for Africa's HIV Treatment Gap

Haven't you always wanted to be a part of something really big? Something that has a real impact and makes a difference in the world?

Imagine if you were diagnosed with a life-threatening illness. You panic. You experience extreme stress dealing with this news. You wait a while for the news to sink in and then slowly tell your family members. There are tears and anger. You, and they, are heartbroken and can't understand how or why this should happen to you.

You slowly adjust to the news, dealing with family, friends and your own emotions. You join a support group and at one meeting you hear about life-saving medications that are available. Members of your support group who are on the medications tell you that they had been getting weaker and thought they were going to die but once they started the treatment they quickly felt stronger and had more energy.

At your next medical appointment you speak about these treatments. You want to benefit from them as you have been experiencing some of what you now know are symptoms of more advanced illness. The nurse avoids looking at you directly. She says you are not ready. You talk about your symptoms and how weak you have been feeling. Eventually you manage to pry out of her the information that there are no spaces left on the treatment list. That you cannot start the medications until someone else in your community dies and a space on the treatment list opens up.

When you desperately ask how on earth this could happen, explaining how much you need these medications, how you have to stay alive for your children, you learn that there simply is not enough money and tough decisions have to be made. Your country has not been deemed a development priority and your local health system can't afford to keep the cost of treatment going either, even though they have dramatically increased support to health services in past years.

Imagine how you feel now, knowing that without your medications your condition will get worse and you know you will die -- a death that is completely avoidable. Imagine feeling that the world, including your own country, doesn't care enough to keep you alive.

In some countries this has been a reality. This is surely what will happen more often if we don't keep our promise to get people living with HIV onto medications and keep them in treatment, even in the most difficult circumstances.

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10 Important HIV/AIDS Discoveries

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Only one quarter of the 1.1 million people with HIV have their condition under control, where "under control" means the virus has been suppressed, according to a report released this summer by the Centers for Disease Control and Prevention.
CORRECTION: The first sentence has been reworded to more accurately reflect the number of people with HIV.

Even though two men were, for a time, able to go off antiretrovirals because their HIV had been reduced to undetectable levels after receiving bone marrow transplants, the HIV eventually returned in the men, according to news reports.
In 2012, the news of the men’s undetectable HIV levels made headlines. The men, who were both HIV positive and taking antiretroviral drugs, had received bone marrow transplants for Hodgkin’s lymphoma. They had received the transplants while they were also taking the antiretroviral medication.
However, in late 2013, preliminary results showed that the HIV had returned.
This slide has been updated to note more recent developments related to the procedure.

New HIV infection rates can be dramatically lowered by making antiretroviral drugs free, a study from Canadian researchers found.
The Canadian Press reported on the study, conducted by B.C. Centre for Excellence in HIV-AIDS researchers, which showed that British Columbia -- a province that offers free access to antiretroviral therapy -- had the lowest rate of new HIV infections over a more-than-10-year period, compared with Ontairio and Quebec.

More than half of HIV-infected young people are unaware that they have the virus, according to a Centers for Disease Control and Prevention report.
"Given everything we know about HIV and how to prevent it in 30 years of fighting the disease, it's just unacceptable that young people are becoming infected at such high rates," Reuters reported CDC Director Dr. Thomas Frieden saying.
The report also showed that for young people, 72 percent of the new HIV infections were in men who have sex with men, while almost 50 percent were in young, African-American males, Reuters reported. These figures are based on 2010 data.

The number of people living with HIV has increased by 18 percent from 2001 to 2011, according to a report released this year from the United Nations Programme on AIDS. An estimated 34.2 million people around the world are living with HIV.
The report also showed that deaths from AIDS have dropped, from 2.3 million in 2005-2006 to 1.7 million in 2011, Reuters reported.

According to the same United Nations report, costs for the cheapest UN-recommended antiretroviral therapy drugs have also decreased over the past 10 years, Reuters reported. A year's worth of the drugs used to cost $10,000 in 2000 for one person; now, it costs $100 a year.

The Food and Drug Administration this year officially approved the drug Truvada -- which has been used since 2004 as a treatment for HIV -- to be sold as a preventive measure for people who don't have the infection, but are at high risk for it.
The FDA said that the pill should be considered for preventive use not only by gay or bisexual men who are at high risk for HIV, but also heterosexual men and women who may also face HIV risks, the Associated Press reported.
Heterosexual men and women make up more than one-fourth of new cases of HIV, and "that's not a portion of the epidemic we want to ignore," the CDC's Dr. Dawn Smith, who was the lead author of the new recommendations, told the Associated Press.
The FDA also approved a new drug this year, Stribild, to treat HIV, Reuters reported.

In findings published this year in the journal PLoS Pathogens, scientists from the University of California, Los Angeles found that it's possible to genetically engineer stem cells to attack living HIV-infected cells in mice.
While the study was only for "proof-of-principle," it "lays the groundwork for the potential use of this type of an approach in combating HIV infection in infected individuals, in hopes of eradicating the virus from the body," study researcher Dr. Scott G. Kitchen, an assistant professor of medicine at UCLA, said in a statement.

People should be screened for HIV even if they're not at high risk of contracting the infection, according to draft recommendations released just last month by the U.S. Preventive Services Task Force. The recommendations would mean that everyone between the ages of 15 and 65 should be screened for HIV, even if they're not at high risk for it, Reuters reported.
"The prior recommendations were for screening high-risk adults and adolescents," Dr. Douglas Owens, a member of the USPSTF task force and a Stanford University medical professor, told Reuters. "The current recommendation is for screening everyone, regardless of their risk."

All HIV patients should be treated immediately with antiretrovirals, according to new guidelines issued this year from a panel of the International Antiviral Society-USA, as reported by TIME. The recommendations are counter to previous guidelines, which said that antiretrovirals should only be used if the CD4 count -- a measure of immune cells in a person's body -- becomes less than 350 cells for every mm3 of blood.

The Global Fund to Fight AIDS, Tuberculosis and Malaria was established 12 years ago as a major vehicle to support the achievement of universal access to treatment, prevention, care and support for the three diseases. A broad range of donors have generously supported the Fund and recipient countries are contributing increasing amounts of their own budgets to health concerns, including HIV, TB and malaria.

Over the past few years we have seen unprecedented progress in our response to HIV -- 12 years ago only 50,000 people were receiving anti-retroviral therapies in Sub-Saharan Africa and now that number is 5 million. We have achieved what seemed impossible only a decade ago and we have done it together.

We have begun to voice a reality that was once a dream -- that we truly can bring an end to this epidemic. We know what needs to be done and how to do it. What we need is for the response to continue to be bold and be robustly supported financially so that we can indeed keep those promises we made so many years ago.

If you want to be part of something really big, something that will truly make a difference in our world, then join others in your community, country and globally to work towards a fully-funded Global Fund. Think about those who are living with HIV and cannot access the life-saving medications that are freely available in richer countries. Think of people who die knowing that their deaths could be avoided. And imagine if it was you.